weird new rule

[Adam_W]

I just found out today that the staff at my centre are no longer allowed to turn off a patient's UF, even if too much fluid is being removed. They can administer saline, but they have to leave the UF on until it meets the goal. I know that it is not a good idea to turn the UF completely off with some high-flux dialyzers (like mine), but I got the idea that wasn't the reason for this new rule, because most of the other patients, at least that I know of, use regular dialyzers. When I know that I'm getting way too dry and I start to "crash", I turn my UF off at least for a few minutes (even though it should be on all the time with my dialyzer), and then I get usually about 200cc of saline. When I feel better, the UF is usually turned back on at the minimum UFR for high-flux dialyzers, which is 300ml/hr on the 2008H. I'm wondering if I'm missing something here, or if this is just another one of those rules that doesn't make sense. Take care.

Adam

[stauffenberg]

And of course, the more saline you get during the treatment, the more thirsty you will be when you leave, and the more fluid gain you will have by the next treatment, leading to more crashing, more saline, etc.  I guess shutting off the UF was just considered too sensible and humane to be consistent with the principles on which dialysis usually operates.

[kitkatz]

I swear the dialysis centers are out to kill us all with new policies that hurt us more than helping us!

[Sluff]

Are you sure the government s not involved here? Seems like stupid rules are usually associated with some kind of government involvement. This is a rhetorical statement and question.

[jbeany]

That's insane. 

[Zach]

It's not the government.

Some centers make those type of rules because staff members have forgotten to turn the UF back on.

I'm not saying that's a good reason, but that's how a dialysis administrator looks at mistakes ... reduce possible human error.

[Sluff]

It's not the government.

Some centers make those type of rules because staff members have forgotten to turn the UF back on.

I'm not saying that's a good reason, but that's how a dialysis administrator looks at mistakes ... reduce possible human error.

I was not serious about the government statement. 

[Zach]

 

[silverhead]

My wife (the patient) and I are very proactive when it comes to her dialysis, she has been on Hemo for about a year, and I really wonder what shape she would be in if we had meekly accepted that orders of the Neph and the nurses. By watching her blood tests carefully we have been able to keep her tests within the "normal" range for quite awhile, if she starts showing signs of to much Potassium for example, we curb the items more strictly from the diet and bring it down, She was experiencing the dreaded headaches in the last half hour of treatment, and great resistance at having the UF flow stopped early, after a few confrontations with the Doc and staff the Neph finally wrote orders that this patient was to set the amount and the limits of her treatment, we still have to refer some nurses and techs to those orders when they try to out think our treatment plans for the day, but on the whole it has worked great for her, we now have found that setting UF draw for 3-1/2 hours and the last 30 minutes just filtering the blood has helped a lot, almost all the techs and nurses say the Fresenius machines cannot be set for that, but we have found it can if they set the machine for 3:30 UF time and start treatment process the RTD time can then be reset with an additional 30 minutes added. many of the "good" techs have commented that we are some of the few that take an active role in their treatment, I cannot understand not getting involved in your treatment, you are about the only one with the goal of bettering your overall health, not just getting the goal of getting through the work shift.......
Tom

[thegrammalady]

My wife (the patient) and I are very proactive when it comes to her dialysis, she has been on Hemo for about a year, and I really wonder what shape she would be in if we had meekly accepted that orders of the Neph and the nurses. By watching her blood tests carefully we have been able to keep her tests within the "normal" range for quite awhile, if she starts showing signs of to much Potassium for example, we curb the items more strictly from the diet and bring it down, She was experiencing the dreaded headaches in the last half hour of treatment, and great resistance at having the UF flow stopped early, after a few confrontations with the Doc and staff the Neph finally wrote orders that this patient was to set the amount and the limits of her treatment, we still have to refer some nurses and techs to those orders when they try to out think our treatment plans for the day, but on the whole it has worked great for her, we now have found that setting UF draw for 3-1/2 hours and the last 30 minutes just filtering the blood has helped a lot, almost all the techs and nurses say the Fresenius machines cannot be set for that, but we have found it can if they set the machine for 3:30 UF time and start treatment process the RTD time can then be reset with an additional 30 minutes added. many of the "good" techs have commented that we are some of the few that take an active role in their treatment, I cannot understand not getting involved in your treatment, you are about the only one with the goal of bettering your overall health, not just getting the goal of getting through the work shift.......
Tom

check out profile 4 setting. it pulls then stops, then pulls again, then stops and is steady for the last part of the treatment. it's the profile my doc recommends. if i start cramping, which is infrequent we just turn it off.  if my center tried to set rules like that my doc would come unglued, and dealing wit an angry doc is a lot worse than dealing with me!

[RichardMEL]

I think you meant 300ml/hour Adam? wow 300ml/minute... I think my fistula would colapse under that

Anyway this is nonsense... the first thing they do when I am about to cramp (or unluckily HAVE cramped) is turn the UF flow off.. or at the very least turn it right down - I am usually good with < 500ml/hour if I'm feeling a crash coming on (luckily I get a warning from my body and can usually tell when things are starting to go bad).

I use profile 1 which starts high and goes down. In the last hour can usually turn it off (the profile, not the UF) and the last hour rate can go down to under 300ml/hour and it is easy to handle.

Profile 4 sounds a bit like profile 3 (which starts pretty high for 30 mins, then goes down to 100 for 30 mins, then back to high (but stepped lower than the first lot) so by the end of the session you end up doing the first half hour at say 300ml/hour and the last half on 100. It's not bad but I switched to profile 1 because there aren't big changes in the flow rate it is a steady decrease and my body seems to tollerate that better.

[Adam_W]

I think you meant 300ml/hour Adam? wow 300ml/minute... I think my fistula would colapse under that

Yes, I meant 300ml/hour. 300 per minute! I don't think ANYONE could handle a UFR like that! I corrected it in my original post.